AHRQ, CDC's Million Hearts Work Together Against Cardiovascular Disease

A June 17 Webinar co-hosted by AHRQ and Million Hearts® demonstrated ongoing support for health care providers who each year treat 1.5 million Americans who suffer a heart attack or stroke.

AHRQ and Million Hearts, an initiative of the Centers for Disease Control and Prevention (CDC), hosted the Webinar to feature findings from Stroke Prevention in Atrial Fibrillation, a research review from AHRQ's Effective Health Care (EHC) Program. The review examined the comparative effectiveness of risk scores for predicting stroke and bleeding events and evaluated the comparative safety and effectiveness of anti-coagulation therapies for preventing stroke. The review found that CHADS2 and CHA2DS2-VASc scores have the best discrimination ability for stroke events in patients with atrial fibrillation; HAS-BLED provides the best discrimination of bleeding risk; and newer anticoagulants reduce stroke and bleeding events when compared with warfarin.

The Webinar featured Sana M. Al-Khatib, M.D., M.H.S., associate professor of medicine at Duke University Medical Center, and Janet Wright, M.D., executive director of Million Hearts.

Wright provided an overview of Million Hearts and its efforts to rally support among communities, health systems, nonprofit organizations, Federal agencies, and private-sector partners to prevent 1 million heart attacks and strokes by 2017.

"As a nation, we can and must do better," she said to the more than 140 health care providers and others who joined the Webinar. "For certain segments of our nation, the burden is even greater. As we work on changing the environment and optimizing care, we need to make sure we are addressing the needs of those who are disproportionately affected by cardiovascular disease."

The Webinar was the latest collaboration between AHRQ and Million Hearts, which has endorsed AHRQ's evidence-based research summaries as information tools for clinicians and patients to work together to explore the benefits and risks of treatment options for heart-related conditions. AHRQ and Million Hearts also co-branded a brochure and fact sheet to educate patients and caregivers about cardiovascular disease. And in April 2012, AHRQ and Million Hearts co-hosted a meeting that explored health care innovations as strategies to prevent heart attacks and strokes. (Select for an event summary or select for videos that highlight one notable innovation.)

An archived version of the Webinar will be available soon for continuing education credit. Additional Webinar collaborators include the Centers for Medicare and Medicaid Services, which will provide continuing education credit for physicians; the American Academy of Physicians Assistants, which will provide accreditation for physician assistants; and the American College of Cardiology, whose ongoing dissemination partnership activities were highlighted during the Webinar.

Slides presented in the Webinar will also be available on AHRQ's National Partnership Network Web page, as well as the EHC Program site.

Dr. Al-Khatib is also featured in a podcast recently released by AHRQ. The podcast highlights findings from another cardiovascular disease-related EHC Program review, Treatment of Atrial Fibrillation, and how the findings can benefit practicing clinicians.

Research in Action: AHRQ’s Spanish-Language Resources Assist a Texas-Based Nurse and a Concerned Caregiver

Gledelyn Alejandro, R.N., president-elect of the Philippine Nurses Association of Texas, was supervising nurses at one of her organization’s community health fairs when a woman discreetly approached her. The woman’s son was struggling with depression, and she did not know how to help him.

Alejandro, recalling the scene at that Irving, Texas, health fair, said she quickly understood the woman's need for Spanish-language information that would help her learn more about depression and understand her son's options for treatment. While arranging for the woman to speak with a counselor, Alejandro also provided a copy of AHRQ's publication, Medicamentos para tratar la depresión: Revisión de la investigación para adultos (Medicines for Treating Depression: A Review of the Research for Adults).

"That mother was extremely appreciative of all the resources and thanked us profusely for our help," Alejandro recalled.

Alejandro's decision to share information from AHRQ's Effective Health Care (EHC) Program is an example of how the Agency's evidence-based resources can help patients and caregivers become better informed about treatment options for chronic health conditions.

In addition to the EHC Program publication on medications for depression, Alejandro's team distributed two additional resources: Measuring Your Blood Pressure at Home: A Review of the Research for Adults and Methods for Delivering Insulin and Monitoring Blood Sugar: A Review of the Research for Children, Teens, and Adults With Diabetes. Fair attendees were also encouraged to watch videos promoting AHRQ's Treatment Options: Explore. Compare. Prepare. initiative, which encourages patients and caregivers to access AHRQ's full inventory of more than 50 publications that summarize the benefits and risks of treatment options for conditions ranging from arthritis to autism to migraine headaches. AHRQ's information tools and resources were a terrific complement, Alejandro said, to the blood pressure and glucose checks performed by her team of volunteer nurses.

"I want to be sure our team never lets a patient walk out without giving them at least one or two educational resources," Ms. Alejandro said. "The AHRQ materials are presented at such an effective level for patients, and they really appreciate how easy they are to understand. It's a real joy for us to be able to help patients and get the educational resources out there with the public."

More Resources From the Effective Health Care Program

N-of-1 Trials: User's Guide Available

A publication from AHRQ's Effective Health Care (EHC) Program, "Design and Implementation of N-of-1 Trials: A User's Guide," is an informational resource to researchers, health care providers, patients, and others to improve the understanding of n-of-1 trials and strengthen the quality of evidence that is generated when a n-of-1 trial is conducted. This user's guide explains how to design and use N-of-1 trials over time, outlining potential benefits and barriers, human subject issues, financial considerations, statistical design and analysis factors, required information technology infrastructure for implementation, and training and engagement of providers and patients. Each chapter includes a checklist to help clinicians and investigators determine if key considerations are met. Each of the six chapters can be downloaded for free from the EHC Program Web site.

A research review from AHRQ finds that for adults hospitalized with heart failure (HF), intervention categories that included higher-intensity activities with several elements such as home visits and structured telephone support reduced all-cause readmissions or death at 3–6 months, while lower-intensity activities such as patient education did not. Moderate to strong evidence showed home visiting programs reduced the chance of readmission for all causes, heart failure-specific readmissions, and death 3 to 6 months after the initial hospitalization. Treatments at multidisciplinary heart failure clinics, with an emphasis on physician contact and access to a multidisciplinary care team, reduced the chances of readmission for all causes and death at 3–6 months. As HF is a major clinical and public health problem and a leading cause of hospitalization, future research is needed to determine whether one type of transitional care program is more effective than other types of programs. These findings are available in the research review, Transitional Care Interventions To Prevent Readmissions for People With Heart Failure.

A new streaming video and monograph are now available at no cost from AHRQ's Effective Health Care (EHC) Program, summarizing evidence surrounding screening for Hepatitis C Virus Infection. (http://ce.ahrq.gov/pcor) The video features Roger Chou, M.D., FACP, investigator for the EHC Program, and both resources explore how screening can affect patient outcomes, plus give health care providers and patients information they can use to help make the best possible decisions. Additional AHRQ resources on Hepatitis C testing include the following—A clinician research summary that outlines the clinical bottom line.

Evidence on Depression Treatment for Pregnant and Postpartum Women Lacking

According to a recent research review from AHRQ, there is not enough evidence to determine the relative benefits and harms of depression treatment in pregnant and postpartum women. The association between autism spectrum disorder and depression during pregnancy, antidepressant treatment, or the interaction of the two was not clear since there was no direct comparison made between depressed women who received this treatment during pregnancy versus those pregnant and depressed women who did not. Future research is needed to compare available treatments in groups of women with depression that takes into account the impact of dose, severity of depression, timing of diagnosis, or prior depressive episodes. These findings are available in the research review Antidepressant Treatment of Depression During Pregnancy and the Postpartum Period.